Tobacco smoke: it is time for pediatricians to feel directly concerned.

It has been stated that the epidemic consequences of smoking-associated diseases rank among the greatest public health catastrophes in the past century.1 Many cancers as well as chronic diseases have tobacco as their specific and direct cause or their main risk factor. Not only do active smokers suffer from these diseases, but passive smokers do as well. In children, the deleterious effects of tobacco smoke start by the time of conception, as has been demonstrated in acute lymphoblastic leukemia,2 or anorectal malformations;3 however, without any doubt, they begin in utero. For instance, non-syndromic orofacial clefts4 and likely other malformations5 are related with maternal smoking during pregnancy, as well as low birth weight. The results of some studies have alerted about the poorer lung function in infants whose mothers smoked during gestation,6 a situation which may be related with increased risk of developing asthma later in life.7,8 The list of diseases in which tobacco is a risk factor for morbidity and even mortality, in children and adolescent passive smokers, is long and will likely increase in the future.1,9 Very importantly, children and -to some extent -adolescents do not have the opportunity of opting